Health Care Professionals, Know Your Signs: Are You Moving from Flourishing to Gradual Burnout?

Burnout can happen to anyone. Physician burnout is at a record high in health care organizations. In an article by Seligson, executive vice president and CEO of the North Carolina Medical Society stated in the North State Journal and in Med Page Today, “The mean average burnout rate for all physicians is almost 46 percent and for emergency medicine physicians it’s as high as 60 percent.” Nurses and administrators working in high demand and time compressed work environments may possibly not be too far behind. Burnout affects morale, productivity, retention, absenteeism, presenteeism, teams and even career direction.

The key to tackling burnout is early identification; however, the hardest part of dealing with burnout is identifying it! Due to happening gradually, incrementally over a period of time, it can be easy to dismiss in the early phases as fatigue, irritability or even laziness. Personality traits associated with burnout include perfectionism, rigid thinking and unrealistically high expectations. The daily demands of working in health care environments from making “right” decisions in the midst of being on a treadmill of working with increasingly complex and chronically ill patients, time crunches, immovable deadlines, keeping up with electronic medical records notes to managing the expectations of patients and family members in a world of less resources and high expectations, can result in distress and overly stressed professionals. If not careful, like a thief in the night, these stressors can lead a sapping of energy and zest.

There are certain health care occupations which require a great deal of contact with people, an inordinate amount of responsibility for others, extremely repetitive or monotonous work with low reward can lead to higher burnout potential than other fields. Further, organizations with physically and mentally stressful working conditions are likely to experience higher rates of burnout in its employees. Did you know having responsibilities, tasks, projects without decision-making authority and experiencing inadequate or no feedback about job performance are typical of burnout prone work environments?

If burnout continues for an extended amount of time, as mentioned, the outcome can have an impact on teams and productivity, such as increased medical errors, disengagement, potential increase in interpersonal conflicts and resentment, because the person feeling burnout may be perceived as not carrying their “fair share of the work load.”

Burnout tends to occur more frequently as people age and any situation that consistently requires more energy than it gives rewards. As emotional fuel begins to run low, the phase of “brownout” emerges, characterized by fatigue and irritability, sleep disturbances, changes in eating patterns, and possibly escapist drinking or shopping binges. There may be Indecisiveness, a deterioration in handwriting and decreased productivity may also be present. If these “early warning” signs are ignored, frustration sets in, marked by anger, loss of enthusiasm, cynicism, detachment and possibly physical illness further down the road to burnout.

The final stage of burnout is despair. This despair contains a tremendous sense of failure; pessimism, self-doubt, loneliness and emptiness. People in this stage often talk of wanting to “runaway” and abdicate responsibilities. Physical illness may become incapacitating.

So, how can you tell if you are burning out? Honestly assess yourself on the following psychological, behavioral and physical symptoms can be helpful. Take a moment and think about what may apply to you.

Psychological

  • Nervousness or anxiety
  • Depression and or hopelessness
  • Low tolerance for frustration
  • Fatigue, low energy or apathy
  • Feeling pressured, trapped, tense
  • Insomnia or oversleeping
  • Difficulty concentrating
  • Irritability or angry outbursts
  • Feeling emotionally drained
  • Nagging self-doubt
  • Difficulty turning off thoughts
  • Loss of interest in usual social activities

Behaviors

  • Loss of appetite or overeating
  • Taking tranquilizers or other drugs
  • Smoking or drinking more
  • Withdrawing from close relationships
  • Criticizing or blaming others
  • Watching TV more than two hours per day
  • Feeling overwhelmed by work, yet believing you are indispensable
  • Cynicism about work
  • Difficulty meeting commitments or completing tasks

Physical

  • Muscular tension
  • Back pain
  • Gastrointestinal complaints
  • Irregular heartbeat
  • Grinding or clenching teeth
  • Lingering colds
  • Frequent headaches
  • Dizziness, fainting
  • Weight loss or gain
  • Exhaustion
  • Lack of motivation to get things done
  • Lack of accomplishment
  • Heart palpitations, shortness of breath

Even if you’re a high-risk candidate for burnout, there are things you can do to inoculate yourself against burnout.

Early Signs. Pay attention to the early warning signals that mark the onset of burnout. Don’t dismiss the fatigue, irritability and depression of burnout as just being “a little tired” or in a “bad mood.” The frequency in which you are tired and moody should be a signal of warning.

Realism. Be realistic about your goals and expectations. We rarely get 100 percent of what we want or deliver our 125 percent best effort ALL the time, but 80 or 90 percent often does the job.

Social Support. Develop or improve your social support system. A network of supportive friends, colleagues and family in a community of joyfulness and connectedness are a great buffer against burnout.

Personal Reward. Develop sources of enjoyment and reward other than your regular job. Hobbies, community activities, or aspects of your job other than your regular duties can provide variety and stimulation.

Healthy Habits. Follow good healthy habits — regular exercise, proper diet, and enough sleep assists with protecting against physical symptoms of burnout.

Duke LEAD coaches work with all phases of diminishing energy which may be leading down the path of burnout.  Remember, in the beginning, energy levels and enthusiasm are high and so is job satisfaction. Gradually this gives way to disillusionment and the realization that expectations were unrealistic and feeling ineffective, which may lead to confusion and impatience and a vague sense that something isn’t right. People may try even harder to reach goals, but end up feeling bored, frustrated and lacking in self-confidence. Knowing your signs and knowing that you have behavioral health LEAD coaches available to help provide a greater perspective and partnering with you to achieve a greater sense of well-being.


For more information please visit the Duke Professional and Personal Development Program (PPDP) and Leadership and Enhancement Development (LEAD) Coaching and Consulting Services website or contact Program Director Judith Holder at Judith.Holder@duke.edu or (919) 286-1244.

Articles are written by experienced executive, leadership, performance, communication, interpersonal, wellness and life coaches with behavioral health backgrounds and training in social and emotional intelligence, work-related stress and life span development.